How the pill can help endometriosis

Endometriosis is a condition that affects around 11% of American women of reproductive age. The condition is associated with menstrual cramps and pain which is predominantly in the abdomen. Patients may also experience pain during intercourse, when moving their bowels or during urination. Other symptoms can include bleeding or spotting between periods, digestive issues such as bloating, constipation and fatigue. In some cases, endometriosis can lead to fertility problems.

The condition is caused when the tissue that lines the uterus – the endometrium – grows outside of the uterus and into other areas of the body. This can affect the ovaries, fallopian tubes, bladder, bowel, rectum and more rarely, the lungs.

Pain occurs because the tissue outgrowths may swell and begin to bleed which can lead to inflammation and the formation of scar tissue.

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Causes of endometriosis

The scientific community is not entirely sure what causes the condition, but there are a couple of factors that increase the likelihood of developing endometriosis. These include:

Blood flow during menstruation: When tissues shed during menstruation, backward flow can occur, leading to endometriosis.
Hormones: The hormones estrogen and progesterone regulate endometrial tissue growth. Estrogen promotes cell growth whilst progesterone inhibits it. An imbalance in these hormones may contribute to the endometriosis.
Immune system response: A weak immune system may also have an effect on how the body deals with endometrial tissues outside of the uterus.
Genes: There’s evidence that endometriosis may have a genetic component.
Surgical procedures: In some cases, procedures such as a Cesarean section or hysterectomy may lead to endometriosis.

Prevention

Endometriosis is not preventable, but there are a couple of lifestyle changes you can make to minimize your risk. Regular exercise, low body weight, reduced alcohol and caffeine intake have all been shown to reduce levels of circulating estrogen in the female body, lowering the risk of endometriosis.

The birth control pill as a treatment option for endometriosis

Hormonal birth control pills may be a good option to manage the symptoms of endometriosis if you’re not trying to get pregnant. Studies have shown that women who take birth control pills reduce the risk of developing endometriosis. this is likly due to suppression of ovulation leading to a reduction in menstrual blood flow, which may slow down growth of endometrial tissues.

There are various types of oral birth control, but most women are prescribed a pill containing both estrogen and progesterone. However, recent research cautions that combined oral contraceptives may only provide temporary relief from endometriosis while progesterone-only treatments reduce endometrial tissue growth and are more beneficial long term.

The progesterone-only pill (also called the mini-pill) helps to regulate the menstrual cycle and can reduce pain experienced during periods.

Who can take the birth control pill?

Oral birth control for the treatment of endometriosis is not suitable for all women. Your healthcare provider will be able to determine if you qualify by reviewing your medical history. Generally, it is advised that women who are over 35, those who smoke or those with medical conditions known to interfere with the contraceptive pill, not be prescribed the birth control pills.

What treatments for endometriosis are available if I’m trying to get pregnant?

Women who are looking to get pregnant may not want to take the contraceptive pill. Instead, your doctor may prescribe a medication that includes a gonadotropin-releasing hormone stimulant, which works by inhibiting hormones involved in the development of endometriosis.

Surgery may be an option if your symptoms are severe and other treatment options have failed.

References

Endometriosis | Womenshealth.gov. (2019). womenshealth.gov. Retrieved October 17, 2019, from <https://www.womenshealth.gov/a-z-topics/endometriosis#targetText=Endometriosis,women%20between%2015%20and%2044.&targetT>
Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current obstetrics and gynecology reports, 6(1), 34–41. https://doi.org/10.1007/s13669-017-0187-1
Parente Barbosa, C., Bentes De Souza, A., Bianco, B., & Christofolini, D. (2011). The effect of hormones on endometriosis development. Minerva Ginecol., 63(4):375-86.
Hansen, K. A., & Eyster, K. M. (2010). Genetics and genomics of endometriosis. Clinical obstetrics and gynecology, 53(2), 403–412. https://doi.org/10.1097/GRF.0b013e3181db7ca1
Vercellini, P., Eskenazi, B., Consonni, D., Somigliana, E., Parazzini, F., Abbiati, A., & Fedele, L. (2010). Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis. Human Reproduction Update, 17/2: 159-170. https://doi.org/10.1093/humupd/dmq042
Casper, R. (2017). Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertility and Sterility, 107/3: 533-536. https://doi.org/10.1016/j.fertnstert.2017.01.003